Cardiorespiratory assessment

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2PlanOverview of respiratory and cardiovascular assessment to give you a framework on which to base your assessment process when out on clinical placement for the self ventilating adult patientHandout on StudyNetPlease read around in the textbooksCResp Wk 10_ Tut 2_10_11

4Cardiorespiratory assessmentFrom lecture:When do we assess patients?First contactOngoing throughout treatmentBefore and after every patient contactMaybe use more formal outcome measures at certain times during managementBefore dischargeFirst contactOngoing throughout treatmentBefore and after every patient contactMaybe use more formal outcome measures at certain times during managementBefore dischargeCResp Wk 10_ Tut 2_10_11

5How? Subjectively ObjectivelyEverything the patient/other staff tell us about the patient’s conditionObjectivelyEverything we see/identify from charts/measure(remember: points from other modules about writing up etc)Everything the patient/other staff tell us about the patient’s condition- Everything we see/identify from charts/measureCResp Wk 10_ Tut 2_10_11

15Subjective cont Exercise tolerance Depending on the circumstancesHow far without getting SOB? Hills/inclines? StairsHow long do you need to rest for?Anything they can’t do because of their breathingDepending on the circumstancesWhat the patient would like to be able to achieve as a result of physiotherapy intervention (can give good info re. goals/motivating factors)CResp Wk 10_ Tut 2_10_11

16VideoUsing your handouts from StudyNet re Assessment when watching the videoStart to think about the order of questioningThe importance of listening to the answersWhat is the usefulness of the answers – what do they mean?CResp Wk 10_ Tut 2_10_11

23Other outcome measuresExercise tests give an indication of progressBorg scalePerceived Exertion 6-20.12-13 corresponds to 60% of VO2 max.15 corresponds to 75% of VO2 maxBe consistentMRC Dyspnoea Scale – for breathlessnessVisual Analogue Scale (VAS)for breathlessness (specify which is used 0-10 or 0-5)6MWT and modified shuttle walk testWill do in Semester B – maybe mentioned in cardiac rehabilitation next week.6MWT- walk as fast as reasonably possible along flat corridor, rest allowed but included in 6mins. Measure distance, Sats & HR = Endurance. 15% change is clinically significant. Need 3-4 practisesShuttle or “Bleep” test = 10 m oval coned circuit, incremental  speed dictated by tape. ½hr between practice & testMRC –1. Not troubled by breathlessness except on strenuous exercise2. Short of breath when hurrying or walking up a slight hill3. Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace4. Stops for breath after about 100 m or after a few minutes on the level5. Too breathless to leave the house, or breathless when dressing or undressingCResp Wk 10_ Tut 2_10_11

28Then … You should be able to:Identify the patient’s physiotherapy problem listWrite a treatment plan related to the problem listIdentify short and long term goalsN.B. the degree of the patient’s contribution will varyCResp Wk 10_ Tut 2_10_11

29Physiotherapy problem Treatment plan (would need more details)An example of one problem for a patient with newly diagnosed BronchiectasisPhysiotherapy problemDifficulty expectorating retained pulmonary secretionsTreatment plan (would need more details)Teach the patient ACBTPositioning to facilitate drainage of secretionsAdded humidification(Manual techniques)GoalsShort term – to increase the patient’s ability to expectorate pulmonary secretions during physiotherapy treatmentLong term - to enable the patient to be independent in the management of their pulmonary secretions in a monthCResp Wk 10_ Tut 2_10_11

31In conclusionA framework for all respiratory assessments (always includes CVS)Detail will vary according to patient groupPractical this weekSome cardiovascular and respiratory tools of assessment in practiceCResp Wk 10_ Tut 2_10_11

32Learning outcomesidentify the importance of the physiotherapist assessing a patient at the beginning during and at the end of every treatmentidentify the differences and links between the subjective and objective assessmentdescribe the various components of a cardio respiratory assessmentdiscuss the implications of the results of the assessment on the composition of a physiotherapy problem listdiscuss the implications of the results of the assessment on the composition of a physiotherapy treatment planrelate the importance of the cardiovascular system assessment to the assessment of the respiratory systemidentify the components of a cardiovascular assessmentbegin to describe the implications of the results of a cardiovascular assessmentCResp Wk 10_ Tut 2_10_11